Episode 17 Doctor Joanna Moncrieff on psychiatric drug mechanisms of action, antidepressant/antipsychotic withdrawal and the RADAR study 

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This week we interview Doctor Joanna Moncrieff. Dr. Moncrieff is a psychiatrist, academic and author. She has an interest in the history, philosophy and politics of psychiatry, and particularly in the use, misuse and misrepresentation of psychiatric drugs. She is one of the founding members and the co-chair person the Critical Psychiatry Network. The Critical Psychiatry Network consists of psychiatrists from around the world who are sceptical of the idea that mental disorders are simply brain diseases and of the dominance of the pharmaceutical industry.
 
We discuss Dr. Moncrieff’s work to address the realities of psychiatric drugs and the groundbreaking RADAR study which focuses on antipsychotic drugs.
 
In this episode we discuss:

  • How Dr. Moncrieff became interested in Psychiatry
  • That, while working as a junior Psychiatrist, Dr. Moncrieff came to realise the dominance of drugs as a psychiatric treatment
  • Why Dr. Moncrieff founded the Critical Psychiatry Network
  • That it is often difficult to challenge the status quo in Psychiatry
  • Dr. Moncrieff’s work to formulate a drug centred model as an explanation of how drugs work in the body and the comparison to a disease centred model
  • How the chemical imbalance theory of depression is not supported by evidence
  • That psychiatric drugs are mind altering substances in themselves, in other words they alter normal thinking, emotion and behaviour  
  • That much of the research over the decades has ignored the fact that these drugs alter the way that people feel and behave
  • That these drug-induced effects in themselves mean that placebo controlled trials cannot demonstrate that drugs target an underlying biological problem
  • Psychiatric drugs are not sophisticated or targeted treatments for mental illnesses, their effects are general in natureHow patients tend to stay on the drugs because withdrawal is difficult or they feel they may struggle without the effect of the drug
  • As a general principle, people should take the minimum dosage of these drugs for the shortest possible time
  • How case studies of people who have struggled with withdrawal are very important to demonstrate the difficulties and to help with guidance and support
  • How psychiatric drugs cause adaptations in the brain as the brain moves to compensate for the effects of the drug and that this compensation is often responsible for withdrawal effects when the drug is stopped
  • The RADAR study (Research into Antipsychotic Discontinuation and Reduction) which looks at long term use of antipsychotic drugs and provides support to gradually withdraw users from their drugs
  • How this study will both help patients withdraw and also build up experience and knowledge to help others in future
  • The concerns around long term use of antipsychotics and possible harm to the brain

Relevant links

https://joannamoncrieff.com

https://www.psychologytoday.com/blog/rethinking-mental-health/201602/joanna-moncrieff-the-myth-the-chemical-cure

http://www.mentalhealth.freeuk.com/what.htm

https://www.madinamerica.com/2017/05/inconvenient-truths-about-antipsychotics-a-response-to-goff-et-al/

https://www.ucl.ac.uk/psychiatry/antipsychotic-discontinuation-and-reduction



Books

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs

A Straight Talking Introduction to Psychiatric Drugs

The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment

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FULL TRANSCRIPT
E&OE

Episode 17 Doctor Joanna Moncrieff
Full transcript, episode originally aired Friday 12 May 2017

INTRODUCTION

Hi there, thanks for listening to Let's Talk Withdrawal a weekly discussion on antidepressants and the issues surrounding them.

Hello this is James, welcome to episode 17 of Let's Talk Withdrawal, a weekly podcast discussing antidepressants and mental health.

This week I'm honoured to have been able to talk with Dr Joanna Moncrieff. Dr Moncrieff is a Psychiatrist academic and author she has an interest in the history, philosophy and politics of psychiatry and particularly in the misuse and misrepresentation of psychiatric drugs. As an author, Dr Moncrieff has written extensively on psychiatric drugs and her books include; The myth of the chemical cure in 2007; A straight-talking introduction to psychiatric drugs published in 2009 and The bitterest pills the troubling story of antipsychotic drugs in 2013. She is one of the founding members and the co-chairperson of the Critical Psychiatry Network. The Critical Psychiatry Network consists of Psychiatrists from around the world who are skeptical of the idea that mental disorders are simply brain diseases and of the dominance of the pharmaceutical industry. I was keen to talk to Dr Moncrieff about her work to address the realities of psychiatric drugs and the groundbreaking RADAR study which focuses on antipsychotic drugs.

INTERIVEW

James: Dr Moncrieff thank you so much for talking with me today, could I firstly ask you to tell us a little bit about your background and how you came to be working in the psychiatric field?

Dr. Joanna Moncrieff: Yes, so I trained as a doctor, back in the 1980s but I was always interested in philosophical questions I suppose about what it is to be a human being, what's the right way to live, what is knowledge all those sorts of things. So Psychiatry appealed to me because it encompasses some of those philosophical issues. Then when I was working as a Junior Psychiatrist, I got interested in drug treatment really because it was clear that it was such a dominant method of treatment there was almost no one who came in front of a Psychiatrist, even back then, who wasn't on at least one sort of medication and usually several, so that's what sparked my interest in drug treatment in particular.

James: Thank you and can I ask you a little about the Critical Psychiatry Network which I think you're one of the founders of. I wondered if one the motivators to found it was that experience of seeing how powerful a force drug treatment was in Psychiatry?

Dr. Joanna Moncrieff: My concerns about the overuse of drug treatment were definitely one of the stimuli to founding the Critical Psychiatry Network and more than that it was the realisation that the way I saw the effects of the drugs was different from the way they were being presented in the textbooks and in the way that that many of my superiors saw them. So they just thought drugs were a great thing they were making people better making people normal again and that's not what I saw.

What I saw, this was back in the era of the old asylums, I saw whole wards full of people sort of shuffling around clearly very heavily drugged what we might call zombified and other doctors didn't see that. So it was my realisation that people saw different things in the mental health arena and that they saw it in different ways and had completely different understandings about what mental disorders represent and how to go about helping people with them that sparked my motivation to set up a Critical Psychiatry Network because I realised there were other Psychiatrists around who had the same sorts of concerns and I wanted to get us together both to support each other but also to try and be more effective within the field.

James: It must be a very difficult place to occupy because I'm aware of yourself and a few others, but there aren't that many in the Psychiatric field who will challenge their own profession and ask are we doing the right thing by medicating so quickly and medicating so many. I just wondered what your experience was of occupying that contrary position?

Dr. Joanna Moncrieff: I think it is difficult and I think it's got more difficult really over the last few decades as Psychiatry has become more and more preoccupied with biological interventions and investigations and theories. I think if you go back a few decades Psychiatry was more mixed and there was more emphasis on the social, more emphasis on psychotherapy and more of a place for criticism and critics.

James: It’s curious isn't it because, fairly recently we've come to regard the chemical imbalance theory of mental illness as a myth, so really Psychiatry should be more open to challenge but it actually seems to be becoming more entrenched in its views.

Dr. Joanna Moncrieff: Yes I mean there has been I think recently a bit of a reversal certainly in in the popular world you know out there outside Psychiatry I think people have started to become concerned about the huge levels of prescribing about the side effects of these medications and yes I think there's more awareness that they're not just an unmitigated benefit that there are lots of downsides to these drugs, but the majority of the Psychiatric field probably isn't at the same place, hasn't quite developed that awareness yet.

James: Thank you Doctor Moncrieff. I'd like to go into a little more detail about psychiatric drugs if that's okay. You've written extensively on psychiatric drugs, their mechanisms of action and their role in mental health treatment, particularly in the book The Bitterest Pills released in 2013. You formulated the drug centred model to better explain how drugs affect the body. Could you help me understand the difference between a traditional disease centred model and a drug centred model of action?

Dr. Joanna Moncrieff: Yes of course. I think this is the most important point that I've been trying to get over in the last 10 years or so of my career and started from realising that the way that drugs were being presented as working for mental health problems was really just not supported by evidence and not justified and that traditional way of understanding how drugs work is the idea that they are somehow targeting and helping to reverse an underlying brain problem. So, for example, you know the idea that antidepressants correct a serotonin imbalance illustrates that way of thinking. The idea is that depression is caused by an imbalance of brain chemicals like serotonin and that the antidepressants are effective because they help to correct that imbalance they help to restore your serotonin levels.

It sounds very enticing it's nice and simple and you can draw pictures to show serotonin receptors and make it visually appealing but there's just no evidence that depression is caused by a serotonin imbalance or that antidepressants, because they raise levels of serotonin, that there's no support for that idea at all and what I realised we were missing when we were thinking like that about antidepressants and other drugs, is the fact that these drugs are themselves mind-altering substances. So, if you give these drugs to normal people they will make people feel different and sometimes behave differently. Now, different psychiatric drugs have different effects on on the the brain and therefore the mind and some drugs like SSRI antidepressants you know that the common ones like Prozac and Seroxat these drugs have probably relatively subtle effects on people but then there are other drugs like the drugs we now refer to as antipsychotics so that will include things like Seroquel and Zyprexa that have really noticeable and obvious effects and you know immediately people know that they're taking an active substance and it makes them feel a bit groggy and a bit drowsy. So what I realised is that all the research on drug treatments that's been done over the last few decades has totally ignored the fact that these drugs alter the way that normal people feel and behave and obviously that's really relevant if you're giving a drug to someone who who has a mental health difficulty of one sort or another and it's relevant because those effects of the drug might interact with the mental health problems and it's also relevant because it means that placebo controlled trials which are the trials that are set up to establish whether the drugs are helpful or not are invalidated by these effects. They cannot establish whether a drug is correcting an underlying brain disease, because they can't cancel out the mind-altering effects that the drugs have.

James: Thank you and also it seems that in many fields of medicine we have drugs that are well targeted because we understand the underlying disease mechanism well but with mental health issues we really don't have that good and understanding of the basis of these conditions do we?

Dr. Joanna Moncrieff: Absolutely and I think this is such an important point to get across that psychiatric drugs are not sophisticated, targeted medications, interventions that they're just not we do not have the evidence to claim that that's what they're doing and that’s relatively crude instruments make people feel different and we don't even understand quite how they make people feel different. Certainly over the long-term we don't have good information about the sorts of effects they can produce.

James: Well that's certainly true in my own experience because, when my antidepressant was prescribed five years ago, it was sold as a very specific drug to fix a very specific abnormality in my brain and it was like into a diabetic needing insulin and yet over the last year or so I've come to realise that there's no evidence to support that at all but it's still a popular myth that's propagated.

Dr. Joanna Moncrieff: Absolutely and you know there's been so much propaganda about this that most people believe that that is the case and that this is that that idea is well-established when it's absolutely not and can lead as you say to you know very harmful treatments being prescribed that really are not not helpful. So as as you rightly say most people are presented with antidepressants and told they need to take them because they have an underlying chemical imbalance and the antidepressant can put it right. What we should be saying to people if we are offering drugs like antidepressants, is that here is a drug that will make you feel a bit different and that may or may not be helpful, it depends on the individual, how they experience the alterations produced by the drug, what’s going on in their life and what else they need to do. But that it is almost certainly associated with long-term effects that we don't quite understand.

James: I agree and also I wanted to ask what function you felt that psychiatric drugs should play in mental healthcare because clearly they have a role and I don’t think anyone is advocating banning them entirely but as it is at the moment they are the first intervention used in many cases and that certainly was my experience. I just wanted what you felt there correct place was

Dr. Joanna Moncrieff: Well I think it depends on the drug and it depends on the problem and we can't make blanket statements about it. So if someone's very psychotic and really really preoccupied by hallucinations delusions and other strange experiences going on in their head, a drug that calms them down and maybe dampens their thinking processes down a bit might be useful and some of what we call the antipsychotic drugs do that. So I think that antipsychotic drugs can be useful for someone who's acutely psychotic and also some general sedatives to help them feel calmer and help them sleep a probably probably may also be useful in some cases. But that’s a specific situation where someone’s acutely psychotic and so psychotic that they're not able to think themselves out of that state. If someone's depressed or anxious there may be a role for a short-term sedative but it must be presented very clearly to someone as as a drug that's a sedative and we know that sedatives are addictive and you know difficult to stop and that you build up tolerance to them so that all needs to be presented to people to emphasise how important it is that they should only be used short-term. Something like antidepressants for depression I think is more complicated, I think the idea of giving someone a substance that just sort of alters your emotions of it when you're feeling very low might be appealing when someone's feeling really really down it might the idea that there might be a drug that will take the edge off their feelings might be appealing but it worries me because in the long-term people probably need to experience those feelings to come to terms with them and to deal with what it was that caused them in the first place. So I think even though in the short term maybe there's a rationale for using antidepressants which seem to have a sort of slight emotional numbing effect in some cases might be there in the long term it might even actually prevent people from from dealing with things that that need to be dealt with and enabling them to get over their difficulties.

James: That’s very true and does apply in my case and I feel that the adverse effects of my antidepressant have almost prevented me from building up the kind of coping mechanisms that I needed to address the difficulties in my life.

Dr. Joanna Moncrieff: Yes and I think that's a very common experience and I think that is one of the main reasons why so many people get stuck on antidepressants for so long and we’ve got good data that's happening that people are ending up taking them for years and years and years and you know that suggests that either they've tried to come off and it's just been too difficult maybe due to physiological withdrawal symptoms or they get frightened to come off because, as you say they, haven't had the opportunity to build our other ways of coping with with the sorts of difficulties that they experienced.

James: It is quite easy to get six or twelve months into antidepressant treatment and then start as you say to worry about what will happen if you did stop. You think to yourself if I stop my antidepressant all I'll be is back where I was when I first needed to take it anyway and I haven’t perhaps made the necessary changes in my life would done things to make myself psychologically stronger or whatever else it took to address the root cause so the drug is just a sticking-plaster isn’t it?
Dr. Joanna Moncrieff: Absolutely and and one that I think and really reduce people’s confidence because if you come through an episode of depression without using medication or having used it only very briefly, you know that it's what you did they've got you over it but if you’re taking the medication the temptation is even if you you know are not convinced it's true the temptation is to think well maybe it was the antidepressant maybe I do really need it and can't cope without it and you you haven't therefore really got the confidence to stop and as you say when that's combined with experiencing you know physical and emotional withdrawal symptoms that must put people in a terribly terribly vulnerable situation when they're trying to stop medication.

James: I think it does and another concern is that if you look at the Patient Information Leaflet that comes with the drugs it will say keep taking your antidepressants for at least six months even after your depressive symptoms are resolved and that advice in itself can quite easily lead to dependence.

Dr. Joanna Moncrieff: Yes absolutely, I agree. From my point of view people should take the minimum amount of drugs for the shortest amount of time possible that should be a general principle I think.

James: Thank you Doctor Moncrieff and I wanted to ask for your views on psychiatric drug withdrawal. I personally and many people that I've spoken with for this podcast have found reducing or stopping these medications to be extremely difficult, impossible even for some. Despite this many doctors remain unaware or unwilling to accept withdrawal effects are real or they attempt to explain them away as merely psychological in origin. What can we do to better influence and inform doctors so they're able to support people who are struggling with their psychoactive prescription medications.

Dr. Joanna Moncrieff: Good question. I think we need to get much more information out to doctors, GPs and Psychiatrists about the difficulty some people can help with withdrawing from antidepressants and benzodiazepines in particular but all sorts of psychoactive drugs and because as you say there really just isn't adequate awareness out there. The other difficulty is getting material published on this so that there are one or two case studies but because there's such a prejudice in favour of publishing huge studies and randomised controlled trials it's very difficult to get this information into the scientific literature and that really needs to be done and case studies of people who've really struggled with withdrawal are really actually very important to present scientific as scientific information because this is you know we can't set up a huge you know a huge experiment where we put people on this you know we put normal people on these medications for years and then withdraw half of them and leave half of them on that would be the only way of absolutely rigorously testing out what are actual withdrawal symptoms. We can't ever do that study and therefore we really need to document people's experience like yours who had difficulty coming off these medications and as you say it's really not uncommon especially for people who've been taking them for a couple of years or you know years rather than just a few weeks.

James: Well thank you and what I think would really help me and others like me is to be able to find a conclusive scientific paper that demonstrates that dependence and withdrawal effects are far more common than doctors realise. Doctors general view seems to be that withdrawal effects are limited to a few very sensitive patients and they generally resolve within a few weeks but this is very different to the reality that many people experience.

Dr. Joanna Moncrieff:
Yes I mean I’ve come across people you've had to break open capsules and measure out the grains of the drug inside the capsule to try and taper down slowly enough to avoid really really unbearable withdrawal symptoms you know so this is not an uncommon experience to find the physiological process of withdrawal very unpleasant and very prolonged as well.

James: It’s unbelievably cruel isn't it because if we had an alcoholic and we took away their alcohol overnight or somebody that's dependent on nicotine and took away their cigarettes we would expect them to be in a very difficult physical and emotional place and yet we don’t seem to believe the same can be true of quite powerful psychoactive prescription medications.

Dr. Joanna Moncrieff: It’s crucially important to understand that we as a society doctors are prescribing medications that change the brain and you know change the way that it functions change brain chemicals change receptors change it in all sorts of ways that we don't fully understand at all yet and that therefore have these unpredictable consequences in the long-term like causing these protracted withdrawal symptoms. A withdrawal symptom is a symptom that’s caused because an adaptation that the brain or the body has made is no longer compensated for by the presence of the drug. Now that adaptation that's been stimulated by taking the drug that may never go away it may never reverse we just don't know. What we do know is that drugs change the brain but you know that's been demonstrated very clearly in animal experiments and with lots of data from humans and we know also if you look at the addiction field that the people who come off long-term Benzodiazepines or Opiates or other drugs you know we’re not we're not quite sure yet whether their brains ever get back to normal after you know being on mind-altering substances for a long time. So I think overall people's experience seems to suggest that in the end they get back to normal but it may be you know much longer process than we previously thought it to be. So there is that understanding but if the rationale is not clearly stated anywhere the evidence that's been used to to build up those but to justify those practices is difficult to track down. So we really need you know some more clear directives about how to help people to withdraw from a whole variety of psychoactive substances including antidepressants which are so widely used that even if the proportion of people that has difficulty with them with coming off them is quite small that's still going to be a huge huge number of people because they are being you know so liberally prescribed.

James: That’s true and given that just in the UK we prescribed 63 million antidepressants alone in a single year costing the NHS seven hundred and eighty thousand pounds per day even from a purely economic viewpoint there's money to be saved for the NHS by reducing repeat prescriptions for these things and then there's also the difficult to quantify costs of people like me staying on antidepressant or anti-psychotic drugs for 20 or 30 years then the longer-term effects on our health are going to need more time from the health services aren't they?

Dr. Joanna Moncrieff: Absolutely and if you’re struggling with difficult withdrawal symptoms as you try and come off that's also going to affect your effectiveness and productivity and you know have all sorts of economic consequences in that way too.

James: You’re right and the other thing that struck me is almost exclusively my recent interactions with my doctors have been about the medications rather than my original presenting condition. They’re not talking to me about my health and well-being they tend to be should we increase your dosage should we add another drug to the mix should be swap you to something else the discussion almost centres now around the medication.

Dr. Joanna Moncrieff:
It becomes a treadmill I think doesn’t it you know you start on one drug and that probably doesn't solve the original problem so you've still got the original problem and it may give you some further problems so that so one reaction to that which seems to be quite common is to then prescribe another drug or to change the drug to try and address those problems and then you you know get into this whole spiral where you where you end up being tried on you know more and more different sorts of substances with all the problems that that entails.

James: Well I certainly see a lot of evidence of that and one of my hopes with the podcast is that we can capture those user experiences and share them with GPs and Psychiatrists because I personally have found with all to be quite an isolating and lonely experience and because of that I’ve hidden myself away and not challenged my doctors on it because I'm not taken seriously. I believe this creates a hidden problem and that doctors don't generally know how their patients are dealing with these medications because their patients are not telling them.

Dr. Joanna Moncrieff: Absolutely and you know I think that is reflected on the numbers in the numbers of people that aren't just end up stuck on these medications for years. I'm sure that a lot of those people would probably like to try and come off them but it's too difficult to negotiate that with their doctors and you know the withdrawal effects are are too difficult to tolerate without you know really good support from from the professionals. I was going to say the British Medical Association and various other bodies have suggested to the National Institute of Clinical Excellence that produce these guidelines for doctors about different areas of treatment, that they should produce a guideline for withdrawing from psychoactive medications and hopefully that if a guideline like that was produced it would include up-to-date advice on the best way to titrate down from different sorts of substances so I think that could be really useful for people and also actually just a useful way of highlighting the lack of evidence in many places and the concerns we should have about long-term treatment because of that.

James: I think that would go a long way to helping people because, it must be difficult for doctors now because they know the patient in front of them can go on the internet as soon as they get home and they can expose themselves to a range a very good or very poor quality information on their condition, but in this regard the patient being treated is the expert and doctors should be listening to patients experiences of withdrawal. In my experience I've had doctors tell me that withdrawal was nothing more than a recurrence of my depression or anxiety when the issues I was experiencing were very different to when I initially needed help.

Dr. Joanna Moncrieff: I think sadly, sometimes it's easier to blame the patient for the problems than to acknowledge that our treatments are highly problematic. I think some doctors do feel a bit defensive about what they’re prescribing and have a tendency therefore to say it's your fault it’s your problem it's nothing to do with with the medicine and you know I think that's that's really sad. If there was greater awareness that these medications can be so difficult to get off hopefully that sort of tendency would be more uncommon.

James: Well I'm really grateful doctor Moncrieff that you and others are willing to be so open-minded about this and to try and change other's attitudes and to question whether our drug centred model of care is the right one for emotional or psychological distress I'm really pleased that more work is being done so thank you.

Dr. Joanna Moncrieff: It's good that it’s been picked up in the media as well I think you know several newspapers and the BBC and television channels have started to question which as well which is really good.

James: That's true and the more we can gather user experiences together to show that this is actually a more widespread issue the better. I’d like to go on now and ask about the RADAR study if that's okay. The RADAR study, I believe, focuses on antipsychotic drugs and the effects of long-term treatment. Could you tell us about the study, your involvement with it and the desired outcome of the study?

Dr. Joanna Moncrieff: So RADAR stands for Research into Antipsychotic Discontinuation And Reduction and it's funded by the Government research department, that’s the National Institute of Health Research. So I'm really excited because the fact that it's been funded indicates that there is some willingness on the part of the Government research department which is you know staffed by very high level medical researchers, to investigate the consequences of trying to take people off medication or trying to get people's doses down in a substantial way. So what the RADAR study will principally involve and we’ve just started this part of it is a randomised trial where we're going to compare people who stay on their antipsychotic medication with people who have a gradual and supported reduction of that medication. We're doing this study in people who have had psychotic episodes or who have a diagnosis of schizophrenia or a similar diagnosis to that and the reason that it’s funded and that it is being supported both by the Government research department but also by several prominent leading Psychiatrists who've done research on drug treatment before, is because there are more and more concerns that the use of long term antipsychotics can be harmful to the brain and that it may not have all the benefits that it’s generally been thought to have and that's partly because the previous long-term studies have usually involved taking people who've been on the medication for a long time and then taking them off taking some of them off that medication and putting them onto a placebo more or less overnight and as you know and as we've been talking about, if you take someone off a drug that’s been you know working on their brain for years and years and years and changing their brains makeup for years then that will have significant consequences for how they feel and behave and it seemed there seems to be evidence that it may that that shock to the system may even precipitate a psychotic episode so if you take long term treatment and then stop it, especially suddenly, it seems that you may be more at risk of having a relapse over your condition than you would have been if you hadn't got on to the long term treatment in the first place. The other concern is because of the nature of antipsychotic drugs because what they seem to do is dampen down mental processes and slow up people's thinking and movement that there's some evidence that they reduce people's functioning, that they actually make it more difficult for people to go about their everyday lives, to go to work or get involved in other social activities and there’s some evidence that that's the case and and that would follow logically from what we know about the acute effects of these drugs. So the RADAR study is set up to see whether we can gradually take people off this medication or get people down to much lower doses and to see whether we can do that without people having lots of serious relapses and to see whether in the long term that will help people improve people's level of functioning.

James: Thank you that's really interesting and can you tell me how many people will be involved in the study?

Dr. Joanna Moncrieff: So the target number that we've got to involve is just over 400 and we just started so think we've enrolled about five or six people so far but hopefully we'll have higher numbers by the end of this year we’ve got just over two two to three years to recruit people into the study. So it’s going to be big study it's going to take place across many different centers and I'm going to involve you know a lot of effort and cooperation from different mental health services and particularly from consultant Psychiatrists so I am relying on to get the study done relying on consultant Psychiatrists to volunteer to do the study and to help the patients that are randomised into the anti-psychotic discontinuation group to reduce their medications slowly and safely with support and monitoring.

James: Well it's a very exciting piece of work because not only are you getting important data on the long-term effects of antipsychotic medications but you’re also getting direct input an experience of helping patients safely and gradually withdraw from their medication.

Dr. Joanna Moncrieff: Yes absolutely which with antipsychotics like antidepressants there's very little guidance about how to help people come off partly because it's just been assumed that everyone should just stay on them forever so no one's really thought about it in much detail. So I’m hoping that that that's one really tangible helpful thing that can come out of this study is guidance about how best to help people reduce and and what the pros and cons of that process are.

James: And Dr. Moncrieff do you think that general lessons learned from the study could also apply to antidepressants or do you think the mechanisms of action are so different that the knowledge wouldn't be applicable?

Dr. Joanna Moncrieff: Well the fact that the RADAR study has been funded I think shows there's a greater willingness among doctors and Psychiatrists to think that actually we need to have some alternatives to just sticking people on medication for years and years and we really need to put some effort into helping people to come off. So I help hope that from that respect the RADAR study will will provide lessons and and more as opposed it provide encouragement for doctors to think about helping people to come off antidepressants and other classes of psychiatric medication but I think that probably how you do antidepressant withdrawal, the nuts and bolts of it will be slightly different from antipsychotic withdrawal and it it will be different for different antipsychotics and different for different antidepressants as well depending on things like their half life that is how quickly they act and how quickly they're excreted from the body and and other aspects of their effects. So I think withdrawal always has to be individualised both to the person who's withdrawing but also to the drug they're trying to come off so that there are some general lessons that we can learn.

James: Thank you that's great this is a pivotally important piece of work because we do need to fill a gaping hole in knowledge and experience, and this work will inform guidance that doctors can look to when they are presented with people who are struggling with antidepressant or antipsychotic withdrawal.

Dr. Joanna Moncrieff: Yes and just to say as well there are many people who've been stuck on anti-psychotic medication for years who would like an opportunity to try and come off their medication whatever the results or consequences and you know I feel passionately that they should be given that option that they should be supported in that so hopefully this study will enable more people to go down that route if that's what they want. I think that does show that there's you know a greater awareness that we’re using far too many drugs and we need to provide more help for people to get off.

James: Doctor Moncrieff thank you so much for taking the time to chat with me it was such an interesting discussion and thank you too for all of your valuable work in this area.

FEEDBACK

I’d love to hear from you so please get in touch you can email me on feedback@jfmoore.co.uk and I just wanted to take this opportunity to say thank you for listening and for your feedback too. The podcast recently achieved over 10,000 downloads within its first eight weeks which is incredible. I'm so grateful for your support and encouragement too and also I'm keen for as many as possible to discover the podcast in iTunes and you can really help that by leaving a review and a star rating. If you're listening in iTunes now please leave us a review it takes just a couple of minutes but it makes a big difference thank you.

Also having interviewed Dr. Moncrieff today, I wanted to let you know that she's written an excellent piece for Mad in America entitled Inconvenient Truths about Antipsychotics, which is a response to a recent study that claimed that the benefits of antipsychotic drugs outweigh their risks. It's an excellent piece and well worth your time, to read it visit the website madinamerica.com or I'll put a link in the podcast show notes too.

I also wanted to mention this event on Saturday the 20th of May between 11am and 3pm local time at Hardee's Bay Community Church Hardee’s Bay New South Wales Australia there is a showing of Kevin P Miller's film Generation Rx as part of an event for Emerging Proud. Emerging Proud is a campaign about providing hope to people undergoing severe psychological distress or a spiritual crisis and there are launch events taking place on the 12th of May for more information you can visit the website emergingproud.com for details on the 20th of May event you can search in Facebook for Emerging Proud and Generation Rx film event.

Finally if you're struggling with withdrawal yourself and don't know where to turn there are some excellent resources listed on my website
www.jfmoore.co.uk please go and have a look.

DISCLAIMER

Please do not increase decrease or stop your psychoactive prescription medication without the advice and support of a medical or mental health professional.

Thank you so much for listening today and until next time take care.

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